Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC14161 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | DC14161 | CA |
N | 111NX0100X | Occupational Health | DC14161 | CA |
NPI | 1003988023 |
---|---|
Provider Name | Dr. Mark Mullany Molthen |
First Address | Fresno, CA 93710-5279 |
Second Address | Fresno, CA 93710-5279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T05265 | (02) | CA |